The relationship between preoperative abdominal leak point pressure and surgical outcome following retropubic urethropexy for genuine stress incontinence
2000; Lippincott Williams & Wilkins; Volume: 95; Issue: 6 Linguagem: Inglês
10.1016/s0029-7844(00)00626-8
ISSN1873-233X
Autores Tópico(s)Pelvic and Acetabular Injuries
ResumoIntroduction: Whereas standard urodynamic measurements examine discrete parts of urethral function, abdominal leak point pressure (ALPP) tends to evaluate the combined effects of the different continence mechanisms. The technique involves the measurement of the amount of intraabdominal pressure required to overcome outlet resistance and produce leakage. The present study investigates the association between preoperative ALPP and clinical outcome following antiincontinence surgery. Methods: Forty-one patients with genuine stress incontinence (GSI) scheduled for vaginal patch sling (n = 17) or retropubic needle suspension (n = 24) were studied. All patients underwent standard urodynamic testing, including cough-induced ALPP. Abdominal leak point pressure was defined as the single lowest pressure that produces leakage. Results: Sixteen of 17 patients (94.1%) who underwent vaginal patch sling and 17 of 24 patients (70.8%) who underwent retropubic needle suspension demonstrated complete clinical and urodynamic improvement of GSI at follow-up with a negative standing stress test and a positive maximum urethral closure pressure on cough profilometry. Thus, a total of 33 of 41 patients had a successful surgical outcome (group I), whereas 8 of 41 patients (group II) had an unsuccessful repair. The mean preoperative ALPP in group I and group II was 107 cm H2O SD ± 10, and 103 cm H2O SD ± 9, respectively. The difference was not statistically significant (P >0.05). Conclusion: While ALPP measurement may be useful in demarcating the severity of incontinence, it appears that preoperative ALPP does not correlate with surgical outcome.
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